February 24, 2011

Recently a 37 year old female presented at the clinic. She was thin and pallid and was covering her abdomen with both hands. She complained of stomach pain for several months occurring before or after meals. Her abdomen feared cold and enjoyed warmth, she often felt nauseous with the occasional desire to vomit. Her bowel movements seemed to be unaffected. Her stomach pain occurred prior to her menstrual cycle which had also become quite long, dark and unsmooth. In addition the soles of her feet often felt warm. Her mother, who was sitting next to her commented that her daughter really enjoyed spicy foods and ate too much of them, which was probably causing some of her pain. Her mother recently restricted her consumption of these foods.

Her tongue was purplish-dark with stasis macules on both edges. Her right pulse was wiry-thin, and the left pulse was deep-weak. At this point, Professor Fan kindly asked her, “Do you find that you easily get angry”? The patient nodded her head and said “yes, I don’t have a very good temper”.

Professor Fan said that this is a case of Liver Qi depression with a disharmony of the Spleen and Stomach, which can be treated with ‘Huang Lian Tang’ and ‘Si Ni San’ with additions and subtractions.

Formula:

Gui Zhi 9g

Bai Shao 9g

Fa Ban Xia 9g

Gan Jiang 9g

Zhi Gan Cao 15g

Chai Hu 9g

Zhi Shi 9g

Zhi Xiang Fu 9g

Dang Gui 9g

Dang Shen 12g

Da Zao 4 pieces

Sheng Sha Pu Huang 6g

Huang Lian 6g

7 Packages were administered.

A week later the patient returned for a follow up consultation and said her spirits were up and turning for the better. She was so happy to report that after taking the herbs, her stomach felt very comfortable. She was still having one bowel movement a day. Her cycle came and only lasted 4-5 days, was not very heavy and contained small clots. She has had no abdominal pain, her soles no longer felt warm, and occasionally there was a gurgling sound in her abdomen.

Her tongue edges were purplish-dark and her pulse was wiry.

Professor Fan felt that the formula was addressing her condition and prescribed another seven packages of the original formula to consolidate the treatment.

In clause 173 of the ‘Shang Han Lun’ it says;

“When in Cold damage, there is heat in the chest, evil qi in the stomach, abdominal pain, and a desire to vomit, Huang Lian Tang (Coptis Decoction) governs”

In actuality, Huang Lian Tang is Ban Xia Xie Xin Tang with the removal of Huang Qin and the addition of Gui Zhi. It treats stomach heat and spleen cold, while Ban Xia Xie Xin Tang treats damp heat in the spleen and stomach.

Within the formula, bitter Huang Lian is used to descend heat in the upper body, as per the adage “To treat upper body heat, drain with bitterness”. Acrid warm Gui Zhi, Gan Jiang, and Fa Ban Xia are used to raise spleen yang. “With cold in the lower body, scatter with acridness”. Ren Shen, Gan Cao, and Da Zao are used for their sweet flavour to boost the stomach, remembering the adage “The spleen desires warmth, so with tension use sweet foods to moderate”.

Huang Lian Tang is a very useful formula for treating spleen and stomach conditions resulting from spleen cold and stomach heat. When combined with Si Ni San It is able to course the liver, regulate qi and protect liver wood from exploiting spleen earth. In clinical practice we are often able to achieve positive clinical outcomes through this combination.

In this patients’ case, aside from the above mentioned formulas, Professor Fan added Zhi Xiang Fu in order to strengthen the formulas function of coursing the liver. Dang Gui and Sheng Sha Pu Huang were added to nourish and move the blood, and transform stasis.

This case was adapted and condensed from ‘A Taste of Chinese Medical Chicken Soup’ by Xiong Hong